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CVM Flashcards

1
Q

CAUSES OF STE

A
  • Acute pericarditis
  • LV aneurysm
  • Takotsubo
  • Coronary vasospasm
  • Normal variant angina (formerly known as Prinzmetal angina)
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2
Q

CABG indications

A
  • Left main or Left main equivalent disease (proximal LAD + 2vessel OR 3 vessel disease)
  • Multivessel disease + LV dysfunction
  • High risk criteria on stress testing
  • Angina refractory to medical therapy
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3
Q

Nitrate/Nitroglycerin c/i

A
  • use of PDE5 inh
  • Severe AS
  • Hypertrophic CMO
  • Inferior / posterior infarction (danger of hypotension)
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4
Q

Resting HR/BP for BB tx of chronic stable angina

A

HR 55-60

BP <130/80

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5
Q

Diabetic medication classes that benefit CAD

A 
SGLT2 inh (empagliflozin - jardiance) \
GLP 1 agonist (liraglutide - victoza)
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6
Q

HCOM vs MVP murmur with Valsalva or Squatting to standing

A

HCOM - intensity increases

MVP - prolonged murmur (increases duration); mid-systolic click happens earlier

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7
Q

RV diastolic or RA systolic free wall invagination “collapse”

Failure of IVC to diminish or “collapse” during inspiration

A

Cardiac Tamponade

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8
Q

Most effective treatment of Constrictive Pericarditis

A

Pericardiectomy

Sometime can spontaneously resolve or respond to medical therapy with NSAIDs or prednisone

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9
Q

Treatment of recurrent Pericarditis

A

ASA / NSAIDs x 2wks + Colchicine x 3 mos***

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10
Q

EKG findings in Pericarditis

A
  • diffuse STE
  • PR segment depression
  • Q waves don’t develop like they do in MI
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11
Q

Normal splitting of S2 is heard during ? Inspiration OR expiration

A

Inspiration

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12
Q

S2 splitting during both inspiration and expiration happens with what type of murmur

A

ASD

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13
Q

S2 splitting during expiration happens with what types of murmur

A

AS

HCM

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14
Q

Innocent murmurs in Pregnancy

A

Inc P2
S3
Early peaking systolic murmur over the upper left sternal border

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15
Q

Severe AS ECHO finding

indication for valve surgery?

A

valve area <1cm2
mean transvalvular gradient >40mmHg

SYMPTOMS ONLY

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16
Q

Severe AS PE findings

A

late peaking murmur
slow and delayed carotid pulse
murmur obscures A2

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17
Q

AR - valve replacement indications

A

Symptomatic
Progressive LV dilatation
LVEF <50%

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18
Q

Aortic coarctation is associated with what valve disease

A

Bicuspid Aortic Valve

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19
Q

Coarctation of Aorta PE findings

A

Diminished femoral pulses
HTN
Systolic murmur and may have diastolic component as well
Notching of post. ribs on CXR
Indentation of the aortic wall at the coarctation site.

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20
Q

Mitral Stenosis - med management

A

BB or CCB to control tachycardia and prolong diastolic filling

Coumadin for LA thrombus, AF, previous embolic event

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21
Q

Contraindications to Percutaneous mitral balloon commissurotomy treatment for rheumatic MS

A

LA clot
Significant MR
Significant valvular calcifications

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22
Q

AC?

  1. AF + mild AS
  2. AF + mod to severe AS
A
  1. NOAC depending on CHA2DS2-VASc

2. COUMADIN only regardless of CHA2DS2-VASc

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23
Q

Medications that can cause primary MR

A

Ergotamine (serotonin, dopamine, epinephrine A.)
Pergolide (dopamine R A.)
Cabergoline (dopamine R A)
Bromocriptine (dopamine R A)

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24
Q

3 Chronic MR surgery indications

A

Symptomatic but LVEF needs to be >30%
LVEF <60%
Progressive LV dilatation (>40mm) regardless of symptoms

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25
Q

Acute MR treatment

A

prior to SURGERY

  • sodium nitroprusside MAP<60mmHg
  • NE for hypotension
  • intra-aortic balloon pump if unresponsive to therapy
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26
Q

JONES Criteria (acute Rheumatic Fever)

A

Group A strep infection/Elevated strep Ab titer PLUS
2 major OR 1 major +2minor

MAJOR
J oints (mono or polyarthritis)
♥️carditis, valve damage
Nodules (subcut extensor surf)
Erythema marginatum (painless)
Sydenham chorea
MINOR
P olyarthralgia 
E EKG with PR prolongation
A rthralgia
C RP and ESR elevated
E levated temp (T >38C)
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27
Q

Antibiotic of choice for acute Rheumatic Fever

Prophylaxis needed to prevent 2nd infection?

A

PNC

  1. NO CARDITIS: 5yrs or until 21 (whichever is longer)
  2. CARDITIS + NO RESIDUAL HEART DX: 10 yrs or until 21
  3. CARDITIS + RESIDUAL HEART DZ: 10 yrs or until 40
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28
Q

Perioperative AC management for mechanical aortic valve

A

Stop warfarin 5 days before surgery

Restart after surgery

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29
Q

When is INR goal 2.5-3.5 indicated

A

Mitral mechanical valve
Aortic mechanical valve + AF
Dec LVEF
Previous embolism

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30
Q

3 indications for ASD closure

A
  1. evidence of L–>R shunt with pulm flow : systemic flow ratio >1.5:1.0
  2. volume overload of right side
  3. symptoms
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31
Q

DAPT treatment in : NSTEMI with no stent placement

A

ASA81 + clopidogrel x 1 yr

then ASA indefinitely

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32
Q

DAPT treatment in : NSTEMI s/p PCI BMS

A

ASA81 + P2Y12 inh (clopidogrel 75mg qd or ticaglecor 90 mg BID) x 1 yr
then ASA81 indefinitely

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33
Q

Diagnostic study for Arrhythmia:

  • infreq arrhthmias lasting 1-2mins
  • activated by patient so poor choice for pt’s with syncope
A

Event monitor

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34
Q

Diagnostic study for Arrhythmia:

  • EKG lead attached to pt
  • saves previous 1-2 mis of EKG recorded when activated by pt
A

Loop recorder

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35
Q

Diagnostic study for Arrhythmia:

  • long-term continuous EKG monitoring
  • indicated for very infreq arrhythmias lasting 1-2 mins
A

Implanted recorder

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36
Q

AV nodal reentrant tachycardia tx

A 
vagal maneuvers:
-carotid sinus pressure
-gagging or coughing
-valsalva maneuver
-immersing face in ice-cold water 
Medications:
-adenosine (preffered)
-metoprolol, esmolol, verapamil, diltiazem
ABLATION is definitive treatment successful in 95% of cases
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37
Q

EKG findings: AV Reciprocating Tachycardia or WPW pattern

A
  • short PR interval
  • delta wave
  • borderline or prolonged QRS complex
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38
Q

WPW pattern vs WPW syndrome

A

WPW syndrome is : WPW pattern + symptomatic arrhythmias involving the bypass tract

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39
Q

WPW (or AVRT) syndrome tx

  1. Hemodynamically unstable
  2. Narrow complex AVRT
  3. Wide complex, Irregular AVRT
  4. Drug resistant
  5. asymptomatic AVRT (WPW) conduction without arrhythmia
A
  1. Cardioversion
  2. Procainamide (class Ia Na channel blocker)
  3. Ibutilide (class III; delayed K channel blocker)
  4. Ablation
    - -> Radiofrequency is more safer, more cost effective and less invasive than surgical ablation ***
  5. does not require tx or investigation
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40
Q

Medications to avoid with WPW syndrome + AFib

A

CCB, BB, digoxin because can convert AFib to VT / VF

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41
Q

3 MC causes of A Flutter

A

Pulm disease exacerbation
Pericarditis
Following open heart surgery

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42
Q

A Flutter Mx

A

Cardioversion (hemodynamically unstable)

Radiofreq catheter ablation (superior to medical therapy)

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43
Q

Ascending thoracic aneurysm elective repair dimension

Descending thoracic aneurysm elective repair dimension

A

Ascending : ≥ 50-60mm

Descending : ≥ 60-70mm

Symptoms of hoarseness, dysphagia, back pain

Rapid growth >10mm/yr or >5mm/yr for Marfan and other congenital syndromes

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44
Q

Ascending thoracic aneurysm ECHO surveillance

ECHO surveillance if <50mm

A

<45mm : yearly

≥ 45 mm : q 6 mos

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45
Q

Treatment of aortic arch dissection

A

BB

Vasodilator (nitroprusside)

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46
Q

Which antihypertensive medication should be avoided in acute aortic dissection b/c it results in increased shear stress

A

Hydralazine

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47
Q

AAA screening cricteria

A

1 time screening for MEN ≥ 65 yo who have ever smoked

or who have never smoked but have higher family risk

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48
Q

AAA need for surveillance

A

4 - 5.4 cm follow up with US in 6-12mos

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49
Q

ABI

  1. ≤ 0.9
  2. ≤ 0.4
  3. ≥ 1.4
  4. 1 - 1.3
A
  1. PAD
  2. ischemic rest pain
  3. diabetes-related noncompressible calcified arteris
  4. normal
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50
Q

What to do if ABI is ≥ 1.4

A

toe-brachial index

51
Q

claudication due to PAD vs spinal stenosis

A

spinal stenosis claudication occurs with walking, standing(resting). Only resolves when sitting or flexing (bending forward)

52
Q

contraindication to use of Cilostazol

A

decreased LV EF

53
Q

In the absence of active cardiac condition 2 pt situations that do not require preop cardiac risk assessment are

A
  1. low risk surgery (endoscopic, superficial breast, cataract, ambulatory)
  2. patient able to climb flight of stairs, walk on level ground at 4miles/hour ( ≥ 4 METs)
54
Q

Omega 3 FA supplement decreases ?

55
Q

Monounsaturated fats affect on HLD

A

Dec LDL

Either INC HDL or leaves it unchanged.

56
Q

Large a waves and slow/blunted y descent

A

Tricuspid stenosis
Pulmonary stenosis
Pulm HTN
associated with Delayed atrial emptyting

57
Q

Rapid x and y descent

A

Constrictive pericarditis

58
Q

Cannon a wave

A

VTach or Complete heart block

atrium is contracting against closed tricuspid valve

59
Q

Large a and large v waves

60
Q

IE prophylaxis requirement

A

Prosthetic heart valve ***
Previous hx of IE
Unrepaired cyanotic CHD
Repaired CHD with prosthetic material for <6mos post procedure
Cardiac transplant recipients who develop cardiac valvulopahty

61
Q

Which procedures require prophylaxis for IE

A

Procedures on ….
Respiratory tract
Infected skin
Musculoskeletal tissue

62
Q

Equal a and v waves with a single rapid x and attenuated y descent

A

Cardiac tamponade

63
Q

-EKG findings of STE which quickly resolve
-Crescendo-type angina
-CE often normal b/c ischemia is of short duration
is consistent with ….

A

Normal variant angina (formerly known as printzmatel)

64
Q

Normal variant angina tx (2)

A

CCB
Nitrates
to prevent vasospasms

65
Q

Coccaine abuse + BB effect

A

Acute coccaine intox leads to hyperadrenergic state. BB block the beta component of these effects leaving unopposed alpha effect leading to adverse consequences

66
Q

Thrombolytic therapy during cp benefits which type of EKG findings ? ***

And harmful for which type of EKG finding?

A

new LBBB > ant STEMI > inf STEMI

harmful if ST depression

67
Q

Equalization of diastolic pressure are seen in (2)

A

Constrictive pericarditis

Cardiac tamponade

68
Q

Indication for dipyridamole nuclear stress test (vs exercise treadmill test)

A

AFib

——-

69
Q

Which electrolyte abnormalities cause prolonged QT (3)

A

HypoCa
HypoMg
HypoK

70
Q 
Anterior MI
Anteroseptal 
Anterolateral
Lateral
Inferior
Posterior
A 
V2-4
V1-4
V4-6, I, aVL
I, aVL
II, III, aVF
tall R in V1-2 and ST depression in V1-2
71
Q 
Pt with AFib on Coumadin
undergoes PCI which is more appropriate?
--cont warfarin alone
--cont warfarin + ASA
--cont. warfarin + P2Y12inh 
--cont. warfarin + DAPT
A

–cont. warfarin + P2Y12inh

72
Q

4 components of Tetralogy of Fallot (TOF)

A 
V-ROAR-V
V--VSD
RO--Right ventricular Outflow obstruction
OA--Overriding aorta 
RV--Right Ventricular hypertrophy
73
Q

NSTEMI pt blood thinner regimen

A
  1. ASA
  2. P2Y12 inh ticagrelor > clopidegrol
  3. parenteral AC :
    - –>enoxaparin SC
    - –>bivalirudin IV
    - –>fondaparinux SC
    - –>unfractionated hep (preferred with GFR < 20 or ESRD on dialysis patients)
74
Q

Using antipsychotic in patient with prolonged QT interval increases the risk of

A

POLYMORPHIC VTach (torsades de pointes)

75
Q

Indication for emergent Aortic Dissection for type B aortic dissection

A

Occlusion of major aortic branch leading to end-organ ischemia

Persistent HTN or pain

76
Q

Class I indication for temporary transvenous pacing (5)

A
  • asystole
  • sxic bradycardia
  • bilateral bundle branch block or alternating
  • new or indeterminate age bifascicular block
  • 2nd degree Mobitz type 2
77
Q

Peri-operative mx

  • -pt undergoing hernia repair
  • -on warfarin for AVR with prosthesis
  • -when discontinuing ASA/warfarin 5 Ds before the procedure do you bridge the patient?
78
Q

pulmonary valve stenosis - surgical indication

A

SEVERE pulmonary valve stenosis require

Balloon valvuloplasty or surgical valve replacement regardless of symptoms

79
Q

Severe pulmonary valve stenosis findings

A

Late-peaking palpable systolic ejection murmur

Absence of ejection click

Features of RV pressure overload

80
Q

Severe mitral stenosis (mean pressure gradient >10mmHg) + no symptoms + planning pregnancy … Mx ?

A

MV intervention

81
Q

TEE use indications (4)

A

Endocarditis / Vegetation
Acute MR/AR
Aortic dissection
Prior to cardioversion for Afib/Aflutter

82
Q

Which EKG lead shows ischemic changes first (or is looked at) during exercise stress test?

83
Q

7 EKG changes that create limitation to EXERCISE stress testing? From most concerning to least concerning

A 
WPW, LBBB, paced rhythm
LVH
RBBB
Digoxin
Nonspecific ST changes
84
Q

Contraindication to dobutamine nuclear imaging

A

Arrhythmia***

hyperTension

85
Q

Contraindication to vasodilator (adenosine) nuclear imaging

A

Bronchospasms

Worsen AV block

86
Q

If a patient is able to exercise but does not have normal resting EKG

A

Exercise with nuclear perfusion imaging

87
Q

Treatment of choice for pts that can’t exercise and has contraindications to dobutamine or vasodilator nuclear imaging.

A

CT angiography OR

Coronary angio

88
Q

Which pharmacologic stress test is preferred when pt has LBBB or paced rhythm

A

Vasodilator (adenosine, dipyridamole, regadenoson)

89
Q

PCWP is a measure of

A

LA pressure which represents LVEDP

90
Q

Pulsus paradoxus (inspiratory fall in systolic BP) seen in (3)

A

Pericardial tamponade
Asthma
Tension pneumothorax

91
Q

Pulsus bisferiens (bifid pulse with 2 aortic peaks) seen in (2)

92
Q

PUlsus alternans (strong pulse weak pulse strong pulse) seen in (3)

A

Bigeminal PVCs
Severe LV dysfxn
Severe AS

93
Q

JVP

Large a wave is seen with (3)

A

TS
Severe PS
Severe noncompliant RVH

94
Q

Irregular Cannon a waves (a is contracting against closed TV)

A

A-V dissociation

  • -> VT
  • ->3rd degree AVB
  • ->ventricular pacing in a pt with sinus rhythm and complete heart block
95
Q

Rapid x and y descent

A

Constrictive pericarditis

Restrictive CMO

96
Q

Rapid x descent with loss of y descent

A

Cardiac tamponade

97
Q

Large v waves (RV contracts but TV is not entirely closed) - 2

A 
RV infarction (w./ kussmaul sign)
TR
98
Q

How do you differentiate Constrictive pericarditis and

Restrictive CMO looking at JV pressure

A

Rapid x and y descent in both

Constrictive - Kussmaul sign and diastolic knock

Restrictive - no diastolic knock

99
Q

In general during inspiration Right sided murmurs are louder…
Which Right sided murmur is SOFTER during inspiration?

A

Pulmonic Stenosis. which occurs with congenital pulmonic stenosis

100
Q

Prognosis of CAD determined by these (3) factors

A

LV function
Exercise capacity < 4
Severity of angina

101
Q

Most predictive RF for the presence of CAD

A

DM&raquo_space; Active smoking

102
Q

Which 4 groups benefit from statin

A
  1. clinica AS CVC (CAD, CVA, PAD)
  2. LDL ≥ 190
  3. LDL 70-189 + DM
  4. LDL 70-189 + 10 yr risk of ≥7.5%

Both 3 and 4 are ages 40-75yo

103
Q

When to give Fibrinolytic therapy in a nonPCI facilitated hospital

A

If the PCI capable hospital is > 120 mins away

Symptom onset 12 hours

104
Q

Indication for ICD implantation prior to discharge s/p STEMI

A

Sustained VT/VF > 48 hrs after STEMI

provided the arrhythmia is not due to transient ischemia, reinfarction, or electrolyte abnormality

105
Q

Pulsus parvus et tardus in carotid pulse is commonly seen with which VHD

106
Q

Late systolic murmur at the apex

107
Q

3 Holosystolic murmurs

108
Q

Redundant tricuspid leaflet arising lower in the ventricle which makes RA appear huge +/- TR murmur

A

Ebstein Anomaly

– associated with WPW syndrome

109
Q
  1. Murmur gets louder with valsalva for AS or HCOM
  2. Murmur gets softer with valsalva for AS or HCOM
  3. Carotid pulse has rapid upstroke and rapid downstroke- bifid
  4. Carotid pulse is delayed
A
  1. HCOM
  2. AS
  3. HCOM
  4. AS
110
Q

3 BB shown to prolong survival in HF

A

Bisoprolol 10mg qd
Carvediolol 25mg bid
Metoprolol sustained release 150-200mg qd

111
Q

In hypertrophic CMO does severity of LV outflow gradient correlate or increased with the risk of sudden death

A

NO; can correlate with the severity of disease

112
Q

HCOM therapy goals

A
  1. slow down the heart HR50 with BB or verapamil

2. inc LV volume so it opens up outflow track

113
Q

2 meds that inc risk of constrictive pericarditis

A

Procainamide

Hydralazine

114
Q

Complication of recurrent Pericaditis

A

Constrictive pericarditis

115
Q

Common causes of Constrictive pericarditis (6)

A 
Idiopathic
Post viral 
TB - in developing countries
CTS 
Radiotherapy
Coccidiomycosis
116
Q 
Kussmaul sign (insp rise in JVP)
Large x and y descent
Pericardial knock
Calcification of pericardium 
Thickened pericardium 
is c/w
A

Constrictive Pericarditis

117
Q

Gold standard test to differentiate between Constrictive Pericarditis and Restrictive CMO

118
Q

F>M
Abnormal flow from Aorta to Right side of heart
Differential cyanosis
Continous machinery murmur

119
Q

PDA surgical or percutaneous closure indications

A

Symptomatic

120
Q
  • -Coronaries that pass between the great vessels
  • -Sudden death in exercising young ppl
  • -can px with cp with exertion
A

Anomualous Coronary Arteries

121
Q

Heart conditions that have absolute contraindication to Pregnancy (3)

A

Cyanotic CHD
Eisenmenger’s
Pulmonary HTN

122
Q

2 causes of a pregnant pt ping with new onset Afib and Pulmonary edema

A

MS

Secundum ASD

123
Q

6 Indications for ICD placement in HCOM patients?

A

–massive myocardial hypertrophy (wall thickness ≥30 mm)

–previous cardiac arrest due to ventricular arrhythmia

–blunted blood pressure response or hypotension during exercise

–unexplained syncope

–NSVT on ambulatory electrocardiography

–FHx of sudden death due to HCM

124
Q

Which valve does not need long-term AC ?
Mechanical or
Bioprosthetic

A

Bioprosthetic

CVM (1 decks)

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